Mastering Medicaid Billing & Coding: A Comprehensive Guide
Feb 24, 2025
Navigating Medicaid billing and coding may feel overwhelming for new assisted living providers, but it doesn’t have to be! Understanding the basics and building a clear system can make this process much smoother. In this guide, we’ll break it down so you can manage Medicaid billing confidently.
We’ll cover the basics of Medicaid billing and coding, the services typically covered, and tips for avoiding common mistakes. By the end, you’ll be ready to use Medicaid to support your facility’s financial health while providing excellent care to your residents.
Check out the video, too:
What Is Medicaid Billing and Coding?
Medicaid billing and coding is how providers get paid for services provided to Medicaid-covered residents.
- Coding: This means using specific codes to describe the services you offer. In assisted living, this is often a single code covering daily care and support.
- Billing: This involves submitting those codes to Medicaid for reimbursement.
Each state has its own set of codes and processes, so you’ll need to know your local rules to get started.
Breaking Down Coding in Assisted Living
In healthcare, alphanumeric codes are used to identify services.
For assisted living:
- Single Code System: Assisted living often uses one code that covers all services, like meals, help with daily activities, and housekeeping.
- State-Specific Codes: Each state sets the codes and reimbursement rates, so check with your Medicaid office for details.
How Medicaid Billing Works
Once you know the correct code, here’s how billing works:
- Submit the Code: Enter the service code and the number of units (e.g., days of care) into the Medicaid billing system.
- Reimbursement: Medicaid or a third-party administrator reviews and reimburses you based on the approved rate.
Example States:
- Colorado: Medicaid is state-managed but uses Gainwell for billing.
- Idaho: There are three payers—Idaho Medicaid, Molina Healthcare, and Blue Cross of Idaho. You’ll need certification with each to accept their residents.
Opportunities Beyond Standard Medicaid Codes
Assisted living providers often work with one standard Medicaid code, but you can diversify your income by offering additional services like:
- Transportation Services: Medicaid reimburses for medical transport.
- Adult Daycare Programs: Codes exist for daytime activities and care for seniors.
Pro Tip: Set up separate businesses for these services to simplify operations and maximize reimbursement.
Tips for Simplifying the Medicaid Process
- Understand Your State’s Rules: Every state has different codes and reimbursement processes. Contact your state Medicaid office or review their provider manual.
- Use Billing Software: Software, like an electronic healthcare record can automate billing and reduce errors.
- Train Your Staff: Ensure your admin team understands Medicaid’s rules and documentation requirements.
- Get Expert Help: Hire a billing professional or join programs like the Success System for tailored guidance.
Why Offer Medicaid in Your Facility?
Some providers hesitate to work with Medicaid because it seems complicated, but offering Medicaid services has big benefits:
- Attract More Residents: Medicaid makes your facility accessible to families who can’t afford private pay.
- Reliable Payments: Once you’re certified, reimbursements are consistent, providing a stable revenue stream.
Take the Next Step
Mastering Medicaid billing and coding is essential for any assisted living provider. When you understand the process and use the right tools, you’ll be able to manage it with confidence, broaden your client base, and keep your business running smoothly.
Start with the basics, build a strong system, and remember—you’ve got this!
Take the Next Step
Navigating Medicaid billing and coding is an essential skill for assisted living providers. By mastering the basics, you can confidently offer Medicaid services, broaden your reach, and ensure smooth operations.
To ensure the success of your assisted living investment, download our Business Plan Checklist which will guide you through the essential steps of creating a solid business plan.
Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.
Show full transcript 👇
Transcript
00:00:00
hey friend I'm Brandon Gustafson and I help beginners like you launch their Assisted Living business in the next 12 months in today's video we're going to be talking about do your home need to be wheelchair accessible to be an assisted living facility if you're interested in that make sure you stick around for today's [Music] video hey before we get started I want to remind you to get over to the website Assisted Living investing. net you can get access to our free underwriting calculator which is a tool that I
00:00:30
created to help you understand if you've got a good opportunity in front of you or not so go and grab that we'll have links down below now let's get into today's video do you need a home that is wheelchair accessible for your assisted living facility it's a great question and something you kind of want to be aware of as you're looking at homes and trying to figure out is this the right property for an assisted living facility so let's chat about that first off let's
00:00:54
understand what it means to be wheelchair accessible I think a lot of people hear that and they they think you know it's got to have a doorway that's wide enough but ends there like no stairs basically right and that's not everything that that goes into it there's actually quite a bit so you need to have a doorway that is wide enough um typically it's going to be wider than than a standard doorway hallways may need to be wider as well you need to not have stairs you need to either have a
00:01:21
ramp that goes up to it and that ramp needs to have a certain ratio for its its slope as well so you need to get familiar with what that looks like you're going going to have to have sinks in the toilets that or in the bathrooms that are wheelchair accessible meaning they don't have anything underneath them so you can Will up underneath the sink so no cupboards basically grab bars in in bathrooms potentially you know if you have stairs in the home you might need to get a a lift or something along those
00:01:48
lines to help out with that there's just kind of a lot that goes into being wilter accessible that you don't think about I don't claim to know all the rules I just gave you five or six things I'm sure I missed dozens of of other ones that you need to be aware of the best way to kind of figure that out is we've talked about this a lot is you start off with City Planning because you want to make sure the house is zoned correctly but then you're going to have the fire department come out and they're
00:02:13
going to do an inspection and one of the big things that they are inspecting is for wheelchair accessibility now there's different classifications of the types of homes that offer Assisted Living so in a classification one facility and we talked about this actually in our fire suppression video so we'll link that up above but a classification one facility means in the event of a fire residents can leave the the building by themselves um in a classification two they need assistance and so you kind of have to
00:02:40
gauge what that's going to mean for you and being wellsh accessible and like there's a lot that kind of goes into that so you just kind of want to understand what that looks like the fire department and their inspection and subsequent approval is what's going to allow you to determine if it needs to be wilter accessible and how or what you need to do to get it to be wheelchair accessible inside of the home now let's talk a little bit about some of the options that you have so once You' kind
00:03:07
of gathered that information you know what wheelchair accessibility is I want to talk to you a little bit about two options that you have in at its core two options to getting started with your Assisted Living business now the first one is buying an existing facility when you buy an existing facility you get grandfathered into Old rules and I've done a video that really hasn't done very well on the channel so should probably go watch it so it just does a little bit better so I'm going to link
00:03:33
that up above for you but what does it mean to be grandfathered in So when you buy an existing facility you get grandfather in to to some of the rules and regulations that that were in place at that time and that could be things around wheelchair accessibility probably still going to have to come up to certain standards and things like that but you you you don't have to follow all of the most current rules which is can be a benefit to you so buying an existing facility can really be beneficial make sure you consider that
00:04:00
as you get started and then when you buy an existing facility you still want to have those approvals still have the conversation with the fire department make sure you're you're in compliance with the understanding that you're going to get grandfathered in to some of those rules now the other option that you look at is converting a home that could be buying a home or leasing a home regardless of which route you go that something you would take into consideration so when you go that route
00:04:23
like we talked about you need to get the the city planning approval from zoning to make sure that it's in place and then have the fire department come out and do their inspections they're going to come in they're going to give you a punch list of these are the things you need to improve you need to have a fire extinguisher here the snc needs to be raised up here doorways need to be widened here they're going to tell you all those things that need to happen whether you're renting or owning the
00:04:45
home and those things need to be implemented and corrected prior to you receiving the approval from the state from the fire department so you can get your license in place so that's something you want to make sure you're going through those steps in SE quence so that nothing falls through the cracks as you get things up and running and like I mentioned some of that's going to depend on the level of care that you're providing to your residents regardless though it it's probably a good idea for
00:05:10
you to consider making some of those changes to be wheelchair accessible um inside of the home it adds some extra value to the home to the property when you eventually look to sell it which is good and then you're just kind of in compliance and you don't have to worry about them changing a rule in 5 years that says now you have to redo all of the things so it's probably worth it to spend some time getting things up and running and getting things in compliance the best that you can within your
00:05:34
budgetary um constraints so I hope you found this video helpful It's Kind it's kind of a different video it's something that a lot of people don't think about but we've been talking about wheelchair accessibility what it is and then how you might Implement that inside of an existing home that you're buying you know an existing business versus doing something where you're doing conversion on a home whether you're buying it or or leasing out that property so that's
00:05:57
something you kind of want to just keep in mind as you go through it if you found this to be helpful make sure you like the video subscribe and ring the bell as well so you get notified when we put out this content we do lives on Tuesdays um so make sure you join those you can jump in and ask questions there um in a live setting or we do our our Thursday videos as well and comment your questions down below so I can kind of help you out through the process and and give you some specific feedback and
00:06:19
guidance through these videos it's it's here to help you my goal is to help beginners like you launch their Assisted Living business in the next 12 months and I can only do that if you're giving me ideas on the things that that you need not not to say I don't have ideas I've got hundreds of them I want to get stuff specific to you um the person that's watching this right now I want to give you what you need so comment that down below um comment your question okay and I want to remind you to get over to
00:06:43
the website as well Assisted Living investing. net to get access to the free resources have our free underwriting calculator we chatted about earlier it's going to help you make a good financial decision so make sure you go and grab that uh get over and check out the business planning guide as well it's the thing that's going to give you the base to help you get started and get where you want to go on your Assisted Living investment Journey so check that out Assisted Living investing. net BPG we'll
00:07:07
link that down below and if you need help need a little bit of extra guidance check out The Mastermind program I love this I love helping the people that are in there and you can check that out at Assisted Living investing. netmaster again we will put links down below for that and if you aren't sure if it's a good fit for you set up for a free strategy session it's kind of you know my way to see if it's a good fit for you and if it's not that's cool you can keep keep watching the stuff um I'm not going
00:07:31
to try to push you into anything I want to make sure that it's a good fit for you to sign up for one of those free strategy calls go to Assisted Living investing. net strategy and we can get that set up for you as well and just fill out the application we'll send you a link and and get something on the calendar for you really I love uh helping people out love coaching people and so that's why I've built the this brand built this program and and everything that goes into it does residential Assisted Living sound
00:07:56
interesting to you but you don't know how to get started at Assisted Living investing done that we're here to help you through the process start to finish to help you reach those the time of Financial Freedom that you're seeking want to thank you for watching and remind you that it doesn't take a lot just a little bit keep going step by step by step I promise you that if you do and you're consistent and persistent you're going to be successful thanks for watching and have a great day
00:08:20
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